MedLab: VITAL SIGNS

AT A GLANCE

Students will become familiar with the field of health science by participating in six hands-on vital
sign activities and applying what they learn to complete a patient diagnosis.

OBJECTIVES ADVANCE PREPARATION

Students will: 1. Determine how you want to divide your students: pairs for the
 Use various medical science Warm-Up and groups of 5 for the Activity.
techniques to accurately 2. Set up six Vital Sign stations: body temperature, heart rate, res-
measure vital signs piratory rate & breathings sounds, blood pressure, and eye
 Identify the different compo- function.
nents of a medical patient 3. Make copies of the station instructions (one copy per station).
chart
4. Make copies of the student worksheets (one copy of each per
 Diagnose a patient by analyz- student).
ing vital signs and other symp-
5. Make copies of Patient Charts (two copies of each patient).
toms

KEY VOCABULARY
MATERIALS
vital signs, baseline vitals, body Per Class:
temperature, homeostasis, hyper- Thermometers
thermia, fever, hypothermia, pulse, Stethoscopes
heart rate, palpate, respiratory Sphygmomanometers (blood pressure cuff)
rate, breathing sounds, wheeze, Pen lights (or small flashlights/phone lights)
stridor, stertor, crackle, stetho- Alcohol wipes
scope, systolic & diastolic blood Instructions
pressure, hypertension, sphygmo-
Per Student:
manometer, patient chart, diagno-
Patient Diagnosis Worksheet
sis, differential diagnosis
Per Group:
SUGGESTED GRADE LEVELS:
Two Patient Charts
8—12

IL LEARNING GOALS WHAT YOU NEED TO KNOW

11.A; 12.A, B; 13.A, B; 22.A, B, C; A doctor's visit is a meeting between a patient and a physician de-
23.A, B; 24.B signed to offer health advice or to assess and treat health condition.
NGSS MS-LS1, HS-LS1 When you go to the doctor‘s office, your vital signs are among the
first things your health professional will evaluate. Vital signs are
PACE YOURSELF clinical measurements that indicate the state of a patient's essential
TWO 45 MINUTE PERIODS body functions. Vital signs are a quick and effective way to monitor
a patient‘s health. Baseline vital signs represent a person‘s typical
state of health. Baseline vitals are determined by using the patient‘s
own well/healthy vital signs. It is important to use the patient‘s base-
line vitals whenever possible since each vital sign has a range of
acceptable values. Even the most well-known—a temperature of
98.6° Fahrenheit—is only a rule of thumb, calculated by averaging
human temperatures. A deviation from the patient‘s baseline vitals
generally suggests a change in physiological function and/or the

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need for medical intervention. There are four main vital signs that are standard in medical settings from
office visits to emergency departments: body temperature, heart rate (pulse), respiratory function
(respiratory rate and breathing sounds), and blood pressure. In this lesson we will also outline one that is
widely used during check-ups and hospital visits—eye function. (Another health indicator typically used in
hospitals– oxygen saturation– is outlined in the ―Alternate Instructional Strategies‖ section below.)

BODY TEMPERATURE
Body temperature is a measure of the internal heat produced by the chemical reactions of processes
such as digestion, liver function, and muscle contraction. Chemical reactions such as these aid the body
in maintaining an internal balance called homeostasis–a narrow range of conditions organisms must
maintain in order to be healthy and function efficiently. Average body temperature is 98.6°F, or 37.0°C,
although this may vary depending on age, weight, and activity level.

Distinguishable variations in body temperature can represent abnormal health conditions. Hyperthermia
is an elevated body temperature related to the body‘s inability to effectively release or reduce heat. The
most common form of hyperthermia is a fever. A fever is the temporary increase in the body's tempera-
ture in response to infection, disease, or illness. Generally, professional medical intervention is necessary
only when temperature exceeds 101˚F, but even a ―low grade‖ fever requires medical attention if it is
persistent/chronic or if it is accompanied by other medical conditions. This figure varies with age, weight,
and activity level. Hypothermia is low body temperature resulting from heat loss. This is typically due to
prolonged exposure to cold temperatures, or blood loss. Both inhibit the body‘s ability to effectively retain
or produce heat. Hypothermia is classified by a body temperature below 96˚F (as measured by an oral
thermometer).

Body temperature is measured with a thermometer. Typically, body temperature is taken orally by plac-
ing a thermometer underneath the tongue; however rectal (in the rectum), aural (in the ear), and axillary
(under the armpit) methods are used when obtaining temperatures for infants and young children or
those who are unable to use a thermometer or are uncooperative with oral temperature measurements.

Figure 1: Various pulse sites on the body

HEART RATE
The pulse, or heart rate, is the number of times the heart
beats per one minute. The heart acts as a pump, which
distributes blood throughout the body by way of blood
vessels. This pumping action consists of two phases: con-
traction and relaxation. The combination of one contrac-
tion phase and one relaxation phase is equal to one
heartbeat. A healthy adult should have a pulse that rang-
es from 60-100 heartbeats per one minute; however this
rate can vary during times of physical exercise, sleep,
stress, or illness.
A pulse can be detected at areas of the body where a
large artery is close to the surface of the skin. By palpat-
ing (pressing down on) these areas, one can feel the
pulse and track the rate of the heart cycle. The most com-
mon pulse points are the wrist (radial) and neck (carotid).
The inner elbow (brachial), where the thigh meets the cengagesites.com

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groin (femoral), the temples (temporal), tops of the feet (dorsalis pedis), behind the knees (popliteal), and
the chest over the heart (apical) are pulse points as well. Besides heart rate, a healthcare provider
checks pulse sites for pulse rhythm and strength to evaluate the health of the patient.

RESPIRATORY FUNCTION
Figure 2: Inhalation and exhalation
Respiratory function is quickly as-
sessed in two ways—respiratory
rate and breathing sounds. A health
professional measures respiratory
rate by counting the number of
breaths taken per one minute. Res-
piration is the process of taking in
oxygen and expelling carbon diox-
ide from the blood. This is done via
the lungs as air is drawn in
(inhaling) and expelled (exhaling)
and oxygen and carbon dioxide
molecules are exchanged with the
blood in the alveoli. One complete
breath consists of two phases: in-
halation and exhalation. A respira- studyblue.com
tory rate is measured when the pa-
tient is at rest, by simply counting the number of breaths in one minute. A healthy, resting respiratory rate
is 12-20 breaths per minute.

Breathing sounds refer to the specific sounds identified in the lungs when a person takes a breath. The-
se sounds should be assessed with a stethoscope. A stethoscope is a medical instrument used to trans-
mit internal body sounds to the ear of the listener. The presence of abnormal breathing sounds may sug-
gest some form of respiratory complication. The five most common breathing sounds are clear, wheeze,
stridor, stertor and crackle. A clear breath is produced Figure 3: Observation of breathing sounds
by the free-flow of air throughout an unobstructed res-
piratory tract (airway). A wheeze is a high-pitched
sound produced by a narrowed or obstructed airway.
They can be heard best during exhalation and are com-
monly associated with conditions such as asthma and
emphysema. A stridor is a higher pitched ―wheeze-like‖
sound heard when a person inhales; usually due to a
blockage of air flow in the trachea or larynx. A stridor
wakemed.org

can be present as a result of laryngitis, tonsillitis or al-

lergic reactions. A stertor is described as a snoring
sound with heavy breathing heard during both inhala-
tion and exhalation that usually arises from the vibration
of fluid or blockage around the throat (pharynx). A ster-
tor can be a result of conditions such as pneumonia or
bronchitis. A crackle is a brief, discontinuous, rattling
sound caused by the explosive opening of the small airways. Crackles are normally a result of inflamma-
tion or infection of the lung‘s airways and more common during the inhalation than exhalation. A crackle

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can also be a sign of pneumonia or chronic obstructive pulmonary disorder (COPD). Using a stethoscope
to listen to a patient‘s breathing through her/his chest and back assists a medical professional in inter-
preting the differences between these somewhat similar sounds.

BLOOD PRESSURE Figure 4: Parts of a manual sphygmomanometer

When the heart beats, it pumps blood throughout
the body to deliver the nutrients, oxygen, and other
materials that it needs. As the blood moves, it push-
es against the sides of the blood vessels and the
force of this pushing is the blood pressure. Blood
pressure is written as one number ―over‖ another
number and is often abbreviated to ―BP‖. The top
number is systolic blood pressure; the highest
level the BP reaches when the heart pumps
(contracts). The bottom number is diastolic blood
pressure; the lowest level the BP reaches as the
heart relaxes between the beats. The adult standard
range for systolic BP is 90 to 120 mmHg (millimeters
of mercury—a common measure of pressure) and
60 to 80 mmHg for diastolic BP. Hypertension, or
high blood pressure, is indicated when systolic pres- nhlbi.nih.gov
sures are greater than 140 mmHg and diastolic pressures are greater than 90 mmHg. Common contribu-
tors to hypertension include: stress, anxiety, obesity, a high-sodium diet and certain genetic factors. Hy-
potension, or low blood pressure, is indicated when systolic pressure is lower than 90 mmHg and dias-
tolic pressure is lower than 60 mmHg. Common contributors to hypotension include: blood loss, severe
infection, allergic reaction, and hormonal imbalances. The medical device used to measure BP is a blood
pressure cuff called a sphygmomanometer (pronounced sfig-mōh-ma-nom-ə-ter); it is composed of an
inflatable cuff to restrict blood flow and a manometer to measure the pressure. The device is typically in-
flated around the upper arm (near the elbow) to restrict blood flow through the superficial (near the sur-
face) arteries. Then, air is slowly let out of the cuff. When enough air has been let out of the cuff to allow
blood to be pushed through the arteries when the heart pumps, the systolic BP is recorded. Air continues
to be released until blood can be pushed through the arteries when the heart relaxes and the diastolic
pressure is recorded. A sphygmomanometer can be manual or digital device, depending on the prefer-
ence of the healthcare provider.

EYE FUNCTION EXAM (Neuro-optometric exam)

A medical professional may determine that a diagnostic eye function exam is in order. During this test,
some of the patient‘s basic neurological health is assessed by determining how well the eye responds to
different stimuli. (Not to be confused with a vision exam.) This test is not part of all basic vital signs test-
ing, but it is a valuable assessment tool for head injuries or when specific ophthalmic (of the eye) or neu-
rological syndromes are suspected. Many health professionals also include this examination in regular
check-ups.
Professionals look for several things during a this type of exam—strabismus/convergence, pupillary re-
sponse (light response), cardinal fields of gaze, and visual acuity (eye chart). These measures, when
compared to the patient‘s baseline, can reveal a lot about the neurological health of the patient. Most

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commonly, the exam is used to determine if a person has suffered concussion—a brain injury due to
head trauma.
Figure 5: Cardinal fields of gaze
The cardinal fields of gaze are the 6 directions of eye move-
ment that are linked to 3 major cranial nerves associated with
the eyes. The directions are - upper-right, upper-left, directly
right, directly left, lower-right, and lower-left. In this test, the ex-
aminer is looking for smooth motion of the eyes. Nystagmus, or
shaky eye movement, can indicate nerve trauma such as may
be found in concussions. In this exam, the medical professional
will hold a finger (or other small object) directly in front of the
patient at approximately 14 inches. The patient will then be
asked to track the object with her/his eyes as it is moved to each
cardinal field of gaze. For example, the object will be moved
from directly in front of the patient to the examiner‘s upper-right
at the extent of the examiner‘s reach and then back to directly in front of the patient before moving the
object to the next cardinal field of gaze. The patient‘s head should remain motionless throughout the test.
Only the eyes should move.

Finally, a visual acuity test may be performed in which the patient‘s vision is Figure 6: Snellen chart
tested using an eye chart (Snellen chart) and compared to his/her baseline
vision. This is different from a vision test done by an eye doctor in that it is
not seeking to diagnose vision deficits/prescribe corrective lenses. Rather, in
this test, patients with corrective lenses should wear them during the test.
The examiner is looking for sudden changes is visual acuity brought on by
head trauma/concussion.

Strabismus—pupils that do not line up properly—and convergence—a type

of strabismus where both pupils point toward the nose/midline of the face—
can indicate concussion, but they are not the only diagnostic test for the af-
fliction. Patient history is especially important for determining the validity of
this test. If the patient has a history of having a ―lazy eye‖ at times, strabis-
mus can be due to stress, fatigue or illness. During this exam, the medical
professional will look carefully at the patient‘s eyes and look for the ―sparkle‖
of the overhead lights or a separate light source shined from slightly above
and in front of the patient. The reflection of the lights should sparkle with a
bright dot in the same position on each eye.

A pupillary response test assesses the automatic responses of the pa-

tient‘s pupils (hence, ―pupillary‖) in focusing and with light exposure. There
Public domain
are four major components of this test. 1. The medical professional simply
looks at the pupils. The pupils should be of equal size. 2. A small light is shined at a slight angle (not di-
rectly) into each pupil for a very brief moment. The pupils of both eyes should constrict (get smaller). The
medical professional looks for ―direct response‖ in the eye that he/she is shining the light on, and a
―consensual response‖ in the other eye; therefore, the light should be shined on the eye twice—one to
observe direct response and one to observe consensual response. Both eyes should be tested in this
way. 3. Pupillary constriction is observed after dilation (getting bigger) due to restriction of light. In this
test, each eye is covered in turn for several seconds and the cover is then removed. The pupil should
constrict with the return of the light to that eye. Consensual response is observed as well but may be
more subtle in this test. 4. Pupillary accommodation is tested. In this test, the patient is asked to focus on

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an object at a distance (the far wall, for example) and then asked to shift focus to something at approxi-
mately 3-4 inches from the patient‘s nose (the examiner‘s pen or finger, for example). When the focus is
shifted from far to near, the pupil should constrict.

PATIENT RECORDS
A single vital sign measurement cannot definitively diagnose a medical condition; but, taken together,
these measurements can help a doctor to determine if further examination and/or testing is needed to
properly treat a patient. A patient‘s vital signs are recorded in a patient chart. A patient chart is a confi-
dential document that contains detailed and comprehensive information. This serves as both a medical
and legal record of an individual's clinical status, care, history, and treatment. Think of a patient chart as a
patient health database—the main source of information the healthcare team needs to treat the patient.
While patient charts will vary depending on the type of medical facility and department (e.g., hospital vs.
clinic, cardiology vs. pediatrics), each charting system contains a common set of components. These
components are:

 Patient information consists of the patient‘s name, date of visit, and, when possible, contact info,
occupation, employer, and insurance carrier.

 Episodic information includes the reason for the patient‘s visit; including specific symptoms and
concerns.

 The triage tag is a result of the process of sorting patients into groups based on their need for, or
likely benefit from, immediate medical treatment. Most patients are separated into one of four catego-
ries: minor, delayed, immediate, morgue.

 Patient history provides a description of the patient‘s health and social history. It also contains infor-
mation about the medical history of the patient‘s family.

 The medical orders component contains orders written by healthcare providers. These can be or-
ders for tests, orders for medication, or recommendations for procedures.

 The lab/test results section identifies the laboratory tests that were performed and the results of
those tests. The test results usually contain the numeric or graphical results and a narrative that de-
scribes the examiner‘s findings.

 The notes section includes additional observations made by a healthcare provider, such as a physi-
cian, physician‘s assistant (PA), or nurse, relating to the patient‘s care.

 The care plans and discharge component documents the treatment goals and plans for future care.
It also contains final instructions for the patient before the chart is closed.
After obtaining a patient‘s vitals and completing components of the patient‘s chart, the medical staff will
make a diagnosis to determine a patient‘s current state of health. A diagnosis is the medical decision
determined after the healthcare team examines all the possible causes for a set of symptoms. A differen-
tial diagnosis consists of listing as many diseases or conditions that can possibly cause the presented
symptoms, followed by a process of elimination, aiming to reach the point where only one disease or con-
dition remains likely. The final result may also remain as a list of possible conditions, ranked in order of
probability or severity. This diagnosis will determine if a patient must be admitted into the hospital for con-
tinuous care or if she/he is stable enough to administer treatment from their own homes.
During this lesson your students will be able identify six common vital signs, list the medical instruments

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used to obtain vital sign measurements, demonstrate the procedure for taking vital signs, and review and
interpret a medical patient chart. They will also have the opportunity to apply this content knowledge by
acting as medical professionals to make differential diagnoses of their own.

WARM UP
1. Use the Vital Signs PowerPoint to review the concept of vital signs; highlight the vitals included in this
lesson and explain why they are monitored in medical settings.
2. After reviewing the PowerPoint, inform students that they will work in partners to measure vital signs:
temperature, heart rate, respiratory rate, breathing sounds, blood pressure, and eye function.

ACTIVITY 1
1. Break students into pairs and divide those pairs equally amongst six vital signs stations.
2. Have students record their vitals on paper (as long as they are comfortable doing so).
3. Each pair will have five minutes at each station to collect and record their data. Every five minutes,
your students will rotate to the next station until all their vital signs have been recorded.
4. Print and, if possible, laminate the directions for each activity below to place at each station.

Temperature:
1. Follow directions on your thermometer. (Use new thermometers or covers for each user.)
2. Record the temperature.
3. Do 10 jumping jacks and immediately take your temperature again.
4. Record your temperature.
5. Fan yourself gently until you feel cooled off.
6. Take your temperature again.
7. Record your temperature.

Heart Rate/Pulse:
1. Have your partner place their arms to the side and bend their elbow. The palm of the hand should
face upward.
2. Using your middle (long) and index (pointer) fingers, gently feel for the radial artery inside your part-
ner‘s wrist. The radial artery is located on the inside of the wrist near the side of your thumb. Note: If
you have difficulty locating the radial pulse on your partner you can try to use the carotid (neck) pulse
for a better reading. Place your index and middle finger on their neck– just under the jawbone and in
a direct line below their temple.
3. Count the number of beats for 30 seconds.
4. Multiply that number by 2 to calculate the number of beats per minute.
5. Record the pulse rate in BPM (beats per minute).

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6. Now, switch roles with your partner.

Respiratory Rate:
1. Before you take your partner‘s respiratory rate, ask him/her to sit up straight with neck and spine in
alignment. Your partner should clear his/her mind, relax and breathe normally.
2. Count the number of breaths your partner takes in 30 seconds. Remember, one complete breath
consists of two phases: inhalation (chest cavity expands) and exhalation (chest cavity contracts).
Note: Placing a hand on your partner’s back (with permission) may help you count breaths better.
3. Multiply that number by 2.
4. Record your partner‘s respiratory rate.
5. Now, switch roles with your partner.

Breathing Sounds:
1. Before you observe your partner‘s breathing sounds, ask them to sit up straight with their neck and
spine in alignment. Encourage them to relax and breathe normally.
2. Take the stethoscope and insert the tips of the device in your ears.
3. Place the stethoscope on your partner‘s back- between the spine and shoulder blades.
4. Listen to your partner‘s breathing sounds for 30 seconds.
5. Record the type of breathing sounds you observed (clear/obstructed). Note: If you are able to distin-
guish the difference between obstructed airway sounds (i.e., wheeze, stritor, stertor, and crackle)
specify that sound on your paper.
6. Clean the earpieces of the stethoscope with an alcohol wipe.
7. Now, switch roles with your partner.

Blood pressure:
1. Have your partner roll up their sleeve, approximately five inches above their elbow.
2. Follow the directions of your sphygmomanometer.
3. Record your blood pressure results.
4. Now, switch roles with your partner.

Eye function:
Pupil alignment—check for strabismus (misalignment of pupils):
1. Sit directly in front of your partner facing each other.
2. Ask your partner to focus straight ahead.
3. Note the position of your partner‘s pupils (small black circles in the center of the eyes). They should
be centered at the fronts of the eyeball.

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4. Note the shine of the overhead lights (or of a pen light or phone light held above and slightly in front
of your partner). The ―sparkle‖ from the lights should be in the same position on each eye.
5. Record the results using the patient‘s left or right sides to describe any deviation from center.
6. Now, switch roles with your partner.

Cardinal fields of gaze—check for smooth eye motion/note nystagmus (―jerky‖ eye motion).
1. Sit directly in front of your partner facing each other.
2. Hold your index fingertip approximately 14 inches in front of your partner‘s nose (center).
3. Tell your partner to follow the movement of your fingertip with his/her eyes only (no head movement).
4. Move your finger on a diagonal up and to your right and note the movement of your partner‘s eyes.
5. Return your finger to center and then move it up and to your left, noting eye movement.
6. Return your finger to center and then move it down and to your right, noting eye movement.
7. Return your finger to center and then move it down and to your left, noting eye movement.
8. Return your finger to center.
9. Note any nystagmus, giving the specific direction(s) on which it occurred. (ie: up and to partner‘s left)
10. Now, switch roles with your partner.

Visual acuity—check for normal (baseline) vision.

1. Have your partner stand at the line several feet from the eye chart. You stand near the eye chart to
check answers.
2. Your partner should read the lines from top to bottom until he/she can no longer read the letters.
Note: if he or she wears glasses, they should be worn during this test as well.
3. Note any significant loss of visual acuity (quality of vision).
4. Now, switch roles with your partner.

(OPTIONAL) Oxygen Saturation (SpO2):

1. Open the pulse oximeter clamp and insert your index finger with the fingernail facing upward (nail
polish should be removed for an accurate reading).
2. Release the clamp and be sure to keep your hand stationary.
3. Turn on the pulse oximeter and wait 10 seconds for your reading.
4. Record your SpO2 results.
5. Now, switch roles with your partner.

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ACTIVITY 2
During this activity, your students will explore common health conditions that medical staff may treat in
the Emergency Room. They will assume the roles of medical professionals by evaluating patient charts,
assessing changes in standard vital sign measurements, and completing a differential diagnosis for their
patient.
Some of the most common reasons people go to the Emergency Room are (in no particular order):

 Headaches  Difficulty breathing/Asthma attack

 Severe allergic reactions  Cuts and Contusions
 Abdominal pain  Upper respiratory infections/Cold/Flu
 Trauma/Broken bones/Sprains  Skin infections
 Chest pain/Heart attack  Unconsciousness

The following chart highlights the changes in vital signs for six of the previously mentioned health condi-
tions:
Conditions
Anaphylaxis Trauma/
Wound Infec-
Asthma (Allergic Cold/ Flu Heart Attack Broken
tions
Reaction) Bones
Symptoms
Baseline- Baseline-
Temperature Baseline Baseline Elevated Baseline
Elevated Elevated
Heart Rate/ Baseline- Low or Baseline-
Elevated Elevated Elevated
Pulse Elevated Elevated Elevated
Respiratory Baseline- Baseline- Baseline-
Elevated Elevated Elevated
Rate Elevated Elevated Elevated
Breathing
Obstructed Obstructed Obstructed Clear Clear Clear
Sounds
Blood Baseline-
Low Baseline Low Baseline Low-Baseline
Pressure Elevated
Oxygen
Low Low Low-Standard Low Low-Baseline Low-Baseline
Saturation
Chest pain, Increased
Out-of-place
narrowed air- pain, swelling,
Nausea with or misshapen
way, nausea, redness or
Tightness/ or without limb or joint,
vomiting, diar- Chest pain or warmth
pain in the vomiting, run- swelling,
Other rhea, swell- pressure, around affect-
chest, ny nose, con- bruising,
symptoms ing, itching, sweating, ed area.
coughing, gestion, bleeding,
include abdominal nausea, light- Drainage from
wheezing, cough, chills, pain, numb-
pain/cramps, headed affected area.
gasping fatigue, aching ness or tin-
unconscious- Nausea, light-
muscles gling, inability
ness, sudden headed, chills,
to move limb
weakness etc.
Commonly, May occur
Fall, motor
after physi- after being
Occurs when Often, but not Occurs when vehicle acci-
cal activity, outside or
Onset of exposed to always, oc- open wound is dents, direct
inhalation of eating certain
symptoms bacteria and curs in later exposed to blow, repeti-
irritants, or foods
viruses adulthood bacteria tive forces,
exposure to (peanuts,
etc.
allergens shellfish, etc.)

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Each condition will not present itself the same way in every individual. Refer to the Teacher Guide for an
explanation of why the vital signs were altered in the presence of these conditions. Please do not use this
chart to self-diagnose. If you or your students are experiencing any symptoms, please see a doctor for an
accurate diagnosis.
1. Use the attached PowerPoint to inform your students about a hospital Emergency Room Department,
common health conditions presented in an ER and ways to assess a patient chart.
2. Write down the ten health conditions highlighted in the PowerPoint presentation on the classroom
board. As a class, have your students brainstorm some of the symptoms that can be associated with
each condition. As your students share their ideas make sure to write the symptoms on the board
next to the corresponding condition. You do not need to write all of the symptoms down, just the
ones that will assist students in making an accurate diagnosis. Note: if you are limited on time, focus
on the six health conditions presented in the chart rather than all ten.
3. Divide your students into small groups and present two patient charts to each group. Give a Patient
Diagnosis Worksheet to each student. Inform your students that each patient will have one of the fol-
lowing conditions: asthma, allergic reaction, cold/flu, heart attack, skin infection, or trauma/broken
bone. For example: Group 1– Patient A and B Group 2– Patient A and C Group 3– Patient B and C
Group 4– Patient D and E Group 5– Patient D and F Group 6– Patient E and F.
4. Make sure each group fills in today‘s date and the patient‘s age on their two charts.
5. Allow students to review the patient charts for 10 minutes. Explain that they will analyze the compo-
nents of the patient chart, particularly vital signs, symptoms and history to diagnose their patients.
6. While students are evaluating the patient charts, make six columns on the classroom board: asthma,
allergic reaction, cold/flu, heart attack, skin infection, and trauma/broken bone.
7. Also, make sure to walk around the classroom to clear up possible health misconceptions you over-
hear your students discuss.
8. Have students record their findings on the Patient Diagnosis Worksheet.
9. At the end of the 10 minutes, have a representative(s) from each group write the patient name in the
column matching the predicted diagnosis. (see table below)
10. After each group has written their selections on the board, discuss each condition by having the stu-
dents explain the process they took to reach their final assessments. If two groups have different
answers, encourage the entire class to share ideas and suggestions to make a final diagnosis. Re-
member to design questions from the information in the Teacher Guide as scaffolds to help students
make conclusions.

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CHECK FOR UNDERSTANDING

1. Why are vital signs important to monitor? Vital signs are clinical measurements that indicate the state
of a patient's essential body functions. A variation in baseline vitals may suggest a change in physio-
logical functioning or alert the need for medical intervention.
2. What are the six vitals signs highlighted in this lesson?

 Temperature: a measure of the balance between heat lost and heat produced by the body
 Heart Rate/Pulse: the number of times the heart beats per one minute
 Respiratory Rate: the number of breaths taken per one minute
 Breathing Sounds: the specific sounds identified in the lungs when a person takes a breath
 Blood Pressure: a measure of the force of circulating blood pushing against the walls of the
blood vessels
 Eye function: a quick, informal assessment of neurological health
3. What are the medical instruments used to measure each vital sign?

 Body temperature is measured with a thermometer.

 To hear the heart, a stethoscope can be placed on the chest over the heart. To feel the pulse,
fingers are placed over areas of the body where an artery is closest to the surface of the skin.
 Respiratory rate is measured by observing the number of times a person takes a breath.
 Blood pressure is measured with a sphygmomanometer.
 Breathing sounds are assess via a stethoscope placed on the chest and/or back.
 A Snellen chart (eye chart) is used to assess visual acuity.
4. What is a patient chart? A confidential document that contains detailed and comprehensive infor-
mation to serve as both a medical and legal record of an individual's clinical status, care, history, and
treatment.
5. What section of the patient chart should be reviewed to determine a patient‘s reason for visit? Epi-
sodic information
6. What section of the patient chart should be reviewed to determine a patient‘s previous health condi-
tions? Patient history
7. What section of the patient chart should be reviewed to determine a patient‘s treatment and future
health regimen? Care plans and discharge section
8. What is a diagnosis? A diagnosis is the medical decision determined after the healthcare team exam-
ines all the possible causes for a set of symptoms.

Alternate Instructional Strategies

 If you are unable to purchase the necessary medical equipment for the Warm Up, continue the les-
son with one of the following options.

 Option 1: Have your students take some of their vitals outside of the classroom.
 Temperature: use thermometer a from home
 Blood Pressure: assign students to visit local pharmacies with free, public blood
pressure monitors
 Here is a website to locate these pharmacies:
http://www.lifeclinic.com/locator.aspx
 Breathing sounds: listen to the various breathing sounds on-line
 Here are a few websites that provide sounds clips

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 VITAL SIGNS

 http://www.wilkes.med.ucla.edu/lungintro.htm
 http://www.practicalclinicalskills.com/heart-lung-sounds-reference-guide.aspx
 http://www.cvmbs.colostate.edu/clinsci/callan/breath_sounds.htm
 Option 2: Select six student volunteers, one from each group, to get their vital sign measure-
ments recorded by the school nurse. The nurse will take the vital signs and can provide you
with an anonymous report (avoiding a HIPAA violation). Alternately, the nurse may provide
each student with their results and they may share with the class if they are comfortable do-
ing so (you may need parental permission for this). Allow the class to review and discuss the
measurements. Also, allow the student volunteers to discuss their experience (i.e., conver-
sations with school nurse, description of equipment used, etc.).
 Option 3: After reviewing the Day 1 PowerPoint, skip the Warm-Up and proceed to the main
activity.
 Before you begin the main activity, assign each group one of the six featured health conditions: asth-
ma, allergic reaction, cold/flu, heart attack, skin infection, and trauma/broken bone. Allow your stu-
dents to investigate how vitals are altered in the presence of these conditions. Have each group pre-
sent their findings to the class.

 If your school has the resources to purchase more materials, blood oxygen saturation is another indi-
cator of health used during hospitalizations (ie, not a general vital sign taken during an office visit)
and can be measured with a pulse oximeter. This measure can replace the eye exam activity (also
not a typical vital sign) or it may be used as an additional activity. See below:

OXYGEN SATURATION
Oxygen saturation (SpO2—saturation of peripheral capillary oxygen) is a measurement of oxygen
carried by the red blood cells throughout the body. As blood is pumped from the heart into the body, it
passes through the lungs where oxygen molecules bind to red blood cells. The percentage of red
blood cells that are fully saturated with oxygen is called blood oxygen saturation. A healthy blood oxy-
gen saturation reading is between 97-100%.

A SpO2 reading is obtained through the use of a pulse oximeter. This is a small device that clips
onto the patient's fingertip or ear lobe and shines two beams of light through the skin of the patient.
Typically, one light is red and one is infrared,. Oxygenated blood absorbs light at 660nm (red light),
where deoxygenated blood absorbs light at 940nm (infra-red). The light beam enables the device to
read small changes in the color of the patient's blood, which in turn provides an immediate estimate
of blood oxygen saturation. The amount of light transmitted through the tissue is converted to a value
representing the percentage of blood saturated with oxygen. Figure 6: Pulse Oximeter w/ monitor

DIFFERENTIATED INSTRUCTION
 Follow the recommendations of any Individualized
Education Programs (IEPs) that you may have for
students in your classes.
 Simplify vocabulary for any students who may need
it. Use ―healthy‖ or ―unhealthy‖ to relate what vital
signs can tell us. (ie: a high temperature is un-
healthy.) Use ‗breathing rate‖ for respiratory rate.
Etc.
ari-cn.com

msichicago.org VITAL SIGNS 13

  Use recorded heartbeat sounds for students with touch sensitivities instead of ask-
ing them to use the stethoscope. These students may also take their own vitals in-
stead of working with a partner.
EXTENSIONS
SCIENCE
There are many health science careers that your students can pursue with varying amounts of schooling
and training. Have your students choose a career in which they are interested from the chart below and
prepare a poster about what steps they would need to take to get there (college, vocational training, vol-
unteer experience, etc.).

GED/HS Diploma Associate Degree Graduate Degree

Graduate Degree
with or w/o with or w/o Bachelor Degree (add'l 3 or more
(add'l 1-2 yrs)
Certification Certification yrs)

Emergency Medical Anesthesia

Cytotechnologist Epidemiologist Audiologist
Technician technician

Healthcare Clinical Laboratory

Dietician Medical Dosimetrist Chiropractor
Interpreter Technician

Medical Coder Dental Hygienist Health Administrator Medical Illustrator Dentist

Medical/Dental
Dietetic Technician Kinesiotherapist Nurse Practitioner Forensic Pathologist
Assistant

Licensed Practical Medical Occupational

Nurse‘s Aide Pharmacist
Nurse Technologist Therapist

Pharmacy
Paramedic Perfusionist Physician Assistant Physical Therapist
Technician

Respiratory Speech Language

Phlebotomist Registered Nurse Physician
Therapist Pathologist

LANGUAGE ARTS
Throughout the lesson, the importance of the entire medical staff has been stressed. Each part of the
team contributes in some way to a patient‘s experience, diagnosis, treatment and recovery. Have your
students research the differences between the following professions: Physician, Medical Resident, Physi-
cian Assistant, Registered Nurse, Licensed Practical Nurse and Medical Assistant. Have students com-
pare and contrast each type of schooling, as well as roles and responsibilities on the job.

msichicago.org
 MATH
Break students into five groups, each group representing one of the five vital signs (breathing sounds ex-
cluded). Provide each of those groups with the Class Vital Signs Worksheet. Remember, that all meas-
urements are anonymous. Give students butcher or graph paper so they are able to create a visual of
results to share with the class. Each group is only responsible for graphing the data of the vital sign they
were assigned. This vital sign data is best displayed in the form of a bar or pie graph. Bar and pie graphs
compare different groups or parts of a whole, where a line graph highlights numerical changes over a pe-
riod of time. Other values to have students calculate include: mean, median, mode, range and percent-
age of students above or below standard measurements.

DIGITAL RESOURCES
 Explore Health Careers:
http://explorehealthcareers.org/en/home

 Listen to breathing sounds:

http://www.wilkes.med.ucla.edu/lungintro.htm
http://www.practicalclinicalskills.com/heart-lung-sounds-reference-guide.aspx
http://www.cvmbs.colostate.edu/clinsci/callan/breath_sounds.htm

 Student-friendly information on anatomy and health:

http://www.kidshealth.org

 Test your own vitals at these locations:

http://www.lifeclinic.com/locator.aspx

RELATED EXHIBITS
YOU! The Experience

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